Tag Archives: HIV

I’ve had many occasions to tell a patient they were HIV(+). Over the last 20 years of my doing so, that message has changed from a death sentence to the acknowledgement of a chronic disease that will need to be battled for a lifetime. That said, the responses still haven’t changed much. There are differences in those for whom the diagnosis is a complete surprise (such as those who would have received it from a blood transfusion) versus those who suspect they’ve been infected (e.g. through IV drug use or risky sexual practices).

I’d imagine that the response is much like it was for an earlier generation when news was received that they’d contracted “The Big C (Cancer).”

As I walk into the room, the patient is already in complete shock. It’s as if they’re thinking about the error of their ways and simultaneously not thinking at all.

The moment requires finesse. It’s easy to blow in and out of a room and drop this bomb of news; after all, it’s a busy emergency room. However, this is important. This is a moment when someone’s life will irreparably change. It will either be the first day of the rest of their life or the beginning of the end of their life.

Patients tend to want this information in private, although to a physician, this is a big red flag. This isn’t private information. Everyone in his/her life will be affected, and furthermore it’s important to start lining up one’s support from the very beginning. I want the patient to have loved ones around to hear this information if they will consent.

“I need you to pay attention, and stay with me.” I’ll tell them this regardless of the outcome, because the fact that this information is being provided in an ER instead of a primary care physician’s office usually means there is some behavior modification that’s going to be needed regardless of the verdict.

Let’s get this out-of-the-way, because that’s what he or she wants to know. “You’re HIV(+).” Again: “I need you to pay attention, and stay with me.”

There are different topics that need to be discussed.

What it means to be HIV(+).

What it means to have AIDS.

How the rest of one’s life is going to look with and without treatment.

What this will mean to one’s family, friends and other loved ones.

How to give the patient the best opportunity for success.

The conversation can be devastating or empowering. You may find this surprising, but a significant number of patients take this news as a rallying cry. In the same way a smoker is suddenly able to stop smoking cold turkey on the day of a heart attack, newly HIV(+) patients find the strength to stop IV drug abuse and alter other high risk activities.

Here’s a bit of a disclaimer. It’s really not all about friends/family support. Friends and family need to be protected. These are the very people who immediately become at risk once a significant other becomes HIV(+), and they deserve to know they are at risk. In many ways it’s easiest to inform them from the very beginning, and it’s certainly in their best interest to know as soon as possible.

Back to you and your diagnosis: you may have noticed I haven’t given you much time to breathe or grieve. There will be plenty of time for you to experience denial, anger, bargaining, depression and acceptance after you leave the emergency room. In real-time, the virus is here, and the risk for risk management begins immediately, especially given it likely wasn’t being handled previously. The most important purpose of your visit wasn’t the launching of your grieving process but the mobilization of resources to treat you and protect others.

A final point: you really don’t want to go through this. Seeing the utter despair, fear and depression indicates that life at best will be very challenging to live. The steps to minimize your risks are so straightforward. It’s agonizing to see those newly diagnosed mentally retracing their steps, knowing that wearing condoms or not being promiscuous or not engaging in needle use was within their control. Make better choices on the front end. After all, you probably wouldn’t knowingly step in front of a moving truck.

Please get tested.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

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For an explanation of the risk of contracting HIV from specific acts of sexual intercourse, click here.

Here are some terms you should understand.

Rimming: oral-anal contact

Fingering: digital sexual stimulation

Now let’s review.

Performing Oral Sex On A Man

You can get HIV by performing oral sex on your male partner. The risk is not as pronounced as it is with unprotected vaginal or anal sex, but oral sex clearly is a mode of transmitting HIV.

You are also at risk for getting other sexually transmitted infections (STIs), including herpes, syphilis, chlamydia and gonorrhea.

Using condoms during oral sex reduces the risk of contracting HIV and other STIs.

Your risk of contracting HIV from oral sex is reduced if your male partner does not ejaculate in your mouth.

Your risk of contracting HIV from oral sex is reduced if you do not have open sores or cuts in your mouth.

Receiving Oral Sex If You Are A Man

The risk of contracting HIV is less with receiving oral sex than many other sexual activities, but it is still present.

Your risk of contracting HIV from receiving oral sex is reduced if you do not have open sores or cuts on your penis.

Oral sex also presents a risk of contracting other STIs, most notably herpes.

Performing Oral Sex On A Woman

Significant levels of HIV have been found in vaginal secretions, so there is a risk of contracting HIV from this activity, although the risk is not a great with other sexual activities.

It is also possible to contract other STIs from performing oral sex on a woman.

There are effective barriers you can use to protect yourself from contact with your partner’s vaginal fluids. You can use dental dams or non-microwaveable plastic wrap to protect against HIV and other STIs. (According to the Centers for Disease Control and Prevention, plastic wrap that can be microwaved will not protect you—viruses are small enough to pass through that type of wrap.)

Receiving Oral Sex If You Are A Woman

The risk for contracting HIV while receiving oral sex is significantly lower than for unprotected vaginal sex, but it is still present.

It is also possible to contract other STIs while receiving oral sex.

There are effective barriers you can use (cut-open unlubricated condom, dental dam, or non-microwaveable plastic wrap) over your vulva to protect yourself from STIs.

Oral-Anal Contact (Rimming)

The risk of contracting HIV by rimming is very low but comes with a high risk of transmitting hepatitis A and B, parasites, and other bacteria to the partner who is doing the rimming.

You should use a barrier method (cut-open unlubricated condom, dental dam, or non-microwaveable plastic wrap) over the anus to protect against infection.

Digital Stimulation (Fingering)

There is a very small risk of getting HIV from fingering your partner if you have cuts or sores on your fingers and your partner has cuts or sores in the rectum or vagina.

The use medical-grade gloves and water-based lubricants can during fingering eliminates this risk.

If you have any additional questions, please feel free to ask questions or provide comments. I cannot more highly endorse the websites at cdc.gov and the US Department of Health and Human Services.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

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Let’s be clear that we’re explicitly discussing the types of sexual behaviors that will lead to transmitting HIV and other sexually transmitted infections (STIs). Over the next two days, we will run the gamut of sexual behavior and its implications.

What I hope to accomplish here is to identify those activities that place you at significant risk for contracting HIV and other sexually transmitted infections (STIs). The take-home message is you really should identify your partner’s health status before you begin sexual activity.

Today we will focus on four types of sexual activity and discuss the risks of each. Let’s start with some terminology.

Receptive sex risks speak to risks to the receiver.

Insertive sex risks speak to risks to the giver.

Bottoming is a way of describing receptive anal sex.

Topping is a way of describing insertive anal sex.

Now, let’s review.

Receptive Vaginal Sex

Vaginal sex without a condom is a high-risk behavior for HIV infection.

HIV is transmitted from men to women much more easily than from women to men during vaginal sex, but the risks are significant for both.

If you currently have an STI or vaginal infection, your risk for contracting/transmitting HIV is increased because your tissue will be inflamed. This has nothing to do with the presence or absence of symptoms.

Female condoms protect HIV infection if used correctly. However, the risk still exists for any area exposed and infected (in the presence of an open sore or bleeding, for example).

Barrier birth control methods (such as diaphragms, IUDs and cervical caps) DO NOT protect against STIs or HIV infection. If infected semen or sperm contracts inflamed or otherwise injured vaginal tissue, the risk of transmission/contraction is present.

Birth control pills do not protect against HIV or other STIs.

Insertive Vaginal Sex

HIV is transmitted from men to women much more easily than from women to men during vaginal sex, but the risks are significant for both.

Condom use is a critical means of protection against STIs that are present without obvious symptoms. Use condoms with a water-based lubricant every time you have insertive vaginal sex to prevent STIs, including HIV.

Receptive Anal Sex (Bottoming)

Bottoming without a condom provides the highest risk for contracting HIV, more so than any other sexual behavior.

HIV has been identified in pre-ejaculatory semen. “Pulling out” prior to ejaculation may not decrease your risk.

Rectal douching before anal sex can increase your HIV risk. Douching irritates the rectal tissue and can make you more receptive to contracting HIV. Soap and water in a non-abrasive manner are adequate means of cleanliness.

If bottoming, you will best minimize the risk of transmitting HIV and other STIs by always using a water-based lubricant with a latex, polyurethane, or polyisoprene condom. This will help to minimize irritation to the rectum during sex and subsequent transmission.

Insertive Anal Sex (Topping)

Topping without a condom is a high-risk behavior for transmission of HIV and other STIs. An infection may be present. If small sores, scratches or tears are also present, they would provide a ready path of entry and transmission of HIV.

Similarly, those same lesions in your partners rectum could harbor infected cells in blood, feces or other fluid, which, when contacted, could infect you through your penis.

Check back for the next post in this series on HIV/AIDS. It will focus on HIV and STD risks from sexual activities other than intercourse.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

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The National Institutes of Health has a nice method of categorizing HIV signs and symptoms, which I’ll replicate here. There are several take home messages, and I’ll use the pictures to communicate them.

HIV Positive Without Symptoms

Many people who are HIV-positive do not have symptoms of HIV infection, and symptoms only evolve as their condition deteriorates toward AIDS (Acquired Immunodeficiency Syndrome). Sometimes people living with HIV go through periods of being sick and then feel fine.

Signs and Symptoms of Early HIV

As early as two–four weeks after exposure to HIV (but sometimes as far out as three months later), people can experience an acute illness, often described as “the worst flu ever.” This is called acute retrovirus syndrome (ARS) or primary HIV infection. This represents the body’s natural response to HIV infection. During primary HIV infection, there are higher levels of virus circulating in the blood, which means that people can more easily transmit the virus to others.

Symptoms resemble a flu-like syndrome, including fever, chills, nights sweats, muscle aches and fatigue. Other symptoms may include a rash, sore throat, swollen lymph nodes and ulcers in mouth. It is important to state that not everyone gets ARS when they become infected with HIV.

Signs and Symptoms of Chronic or Latent Phase HIV

After the initial infection and seroconversion, the virus becomes less active in the body, although it is still present. During this period, many people do not have any symptoms of HIV infection. This period is called the ‘chronic’ or ‘latency’ phase. This period can last up to 10 years—sometimes longer.

Signs and Symptoms of AIDS

While the virus itself can sometimes cause people to feel sick, most of the severe symptoms and illnesses of HIV disease come from the opportunistic infections that attack the infected individual’s compromised immune system.

When HIV infection progresses to AIDS, many people begin to suffer from fatigue, diarrhea, nausea, vomiting, fever, chills, night sweats, and even wasting syndrome at late stages.

Unless symptoms are discovered late, HIV/AIDS is much better being diagnosed early based on risk factors and exposures. That said, use the knowledge provided to prompt evaluation and testing.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

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For an explanation of the signs and symptoms of HIV/AIDS is, click here.

First, let’s address a simple principle. The HIV virus can live and reproduce in high levels in blood other body fluids, including breast milk, rectal mucus, semen (and pre-semen) and vaginal fluids. If any of those fluids are infected and are transmitted to another’s body, that individual can become infected with HIV. In special circumstances (such as healthcare workers), individuals may become exposed to other areas that may contain high levels of HIV, including amniotic fluid (in pregnancy women), cerebrospinal fluid (from the brain and spinal cord) and synovial fluid (from various joints).

Now please take a moment and look at the lead picture. In addition to those circumstances listed, you should know that fluids such as feces, nasal fluid, saliva, sweat, tears, urine or vomit don’t by themselves contain high enough levels to transmit HIV. However, if those fluids are mixed with blood and you have contact with both fluids, you may become infected via these routes.

HIV is transmitted through body fluids in very specific ways:

During anal, oral or vaginal sex: When you have anal, oral, or vaginal sex with a partner, you will have contact with your partner’s body fluids in areas very likely to be high in HIV viral load if your partner is infected. HIV gets transmitted in these instances through small breaks in the surfaces of the mouth, penis, rectum, vagina or vulva. One of the reasons HIV infection rates are higher in individuals with herpes and syphilis is because those diseases cause open sores, creating additional opportunities for HIV-infected body fluids to enter the body.

During pregnancy, childbirth or breastfeeding: Babies have constant contact with their mother’s potentially infected body fluids. Means of transmitting HIV from mother to child include through amniotic fluid, blood and infected breast milk.

As a result of injection drug use: Injecting drugs puts you in contact with blood. If those needles and their contents are contaminated, you can be directly delivering HIV into your bloodstream.

As a result of occupational exposure: Healthcare workers must be constantly diligent against this method of transmission. Risks of HIV transmission to healthcare workers occur through blood transferred from needlesticks and cuts, and less commonly through contact of infected body fluids splashed into the eyes, mouth or into an open sore or cut.

As a result of a blood transfusion or organ transplant: Fortunately, these days, this is very rare given the stringency of screening requirements in the United States, but it is possible to transmit HIV through blood transfusions or organ transplants from infected donors.

How does one get AIDS?

AIDS is a progression of HIV into its later stages and occurs after one’s immune system is severely damaged. You don’t “get AIDS” as much as HIV progresses to AIDS in certain circumstances. Many of us recall that HIV could progress in this way to AIDS in a matter of a few years a few decades ago. Fortunately, with the development of specialized medications in the 1990s, people with HIV are living much longer with HIV before they develop AIDS.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

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After all these years, it’s still an interesting and important enough question to ask and to know how to answer. Most know that AIDS is a devastating disease caused by the HIV virus. However, courtesy of the National Institutes of Health, consider the following:

A – Acquired – AIDS is not something you inherit from your parents. You acquire AIDS after birth.

I – Immuno – Your body’s immune system includes all the organs and cells that work to fight off infection or disease.

D – Deficiency – You get AIDS when your immune system is “deficient,” or isn’t working the way it should.

S – Syndrome – A syndrome is a collection of symptoms and signs of disease. AIDS is a syndrome, rather than a single disease, because it is a complex illness with a wide range of complications and symptoms.

Acquired Immunodeficiency Syndrome is the final stage of HIV infection. People at this stage of HIV disease have badly damaged immune systems, which put them at risk for opportunistic infections (meaning infections not typically present in persons with normal immunity).

You will be diagnosed with AIDS if you have one or more specific opportunistic infections, certain cancers (such as Kaposi’s sarcoma) or a very low number of CD4 cells (a measure of the strength of your immune systems function). If you have AIDS, you will need medical intervention and treatment to prevent death.

Check back to Straight, No Chaser for additional posts on HIV/AIDS, including risk factors and symptoms, progression/complications and treatment.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

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It’s HIV Awareness Month. Have you noticed there’s a lot less chatter about HIV lately? Don’t be lulled into a sense of false security; no, it hasn’t been eradicated. It is still being contracted and is still causing death. Straight, No Chaser will review the latest on HIV in the next few posts.

Looking at the above picture, you would think it shows Ervin “Magic” Johnson donating blood. As most everyone knows, Magic famously retired from the NBA after contracting HIV. As we delve into this Straight, No Chaser, remember two important points.

He never contracted AIDS (we’ll get into the difference between HIV and AIDS in an upcoming post).

He is said to no longer have a detectable viral load of HIV. To paraphrase his words, “I’m cured of HIV.”

So does this mean it’s safe for certain “former” HIV(+) patients to donate blood and engage in activities others who are not HIV(+) can? HIV is a fascinating virus, and the more you know about it, the better off you are, particularly when it comes to protecting yourself from contracting the virus. Several Straight, No Chaser posts have addressed HIV/AIDS, and links are provided below.

In the meantime, consider the following. You’ve had many diseases over your life.

For those of you who have had pneumonia or the flu, did you forever stop kissing once you recovered?

For those of you who have had gonorrhea, syphilis or chlamydia, did you forever stop having sex once you were treated?

For those of you who have had chickenpox, did you forever stop hugging once the virus and rash disappeared?

I bring this points up to point out that at some point, once we truly discover a cure for HIV and actually are successful at eliminating the virus from the body of those infected, it makes sense that you could see someone who was HIV positive donating blood.

However…

That is not a picture of Magic Johnson donating blood. It could be him having blood drawn, or it could be a picture of someone else donating blood with Magic’s head photoshopped on the picture. How do I know this, even without going directly to the source?

In the news…

A case study exists that is about as close to this scenario as it gets. A baby thought to have been “cured” of HIV recently has now been diagnosed with the virus. After being born to a HIV(+) mother, a baby in Mississippi was pre-emptively treated with three antiretroviral drugs for 18 months. Doctors lost track of the infant until she was brought to a clinic for a visit after 10 months of receiving no HIV medication. The team involved found no evidence of the virus in her blood, and declared the girl “functionally cured.” Unfortunately, the virus has now returned. The child, now nearly 5, was found to have high levels of HIV in her blood during a routine visit to the University of Mississippi Medical Center, where she was originally discovered to be HIV(-). Decreased levels of CD4+ cells, the white blood cells targeted by HIV, along with the appearance of antibodies against the virus in her blood, suggest that her remission had come to an end, and that traces of virus remaining in her body had escaped from immune control.

There have now been several cases of cures and relapses. Here’s a bottom line consideration: the earlier that drugs are given, the easier it is for the body to keep the virus in check. However, one should not expect early treatment to completely eliminate HIV.

You may wonder how it’s possible for HIV to become undetectable or to relapse once seemingly “eradicated.” We know the HIV virus can hide away in tissues such as lymphoid and gut cells, as noted in the above picture. Medicines can only reach the virus located in the blood, and if therapy is halted, the virus can emerge from these other locations and relaunch its attack. This explains why most HIV patients need to take antiretroviral drugs daily over the course of their lives,.

The biggest hope for tackling the problem is to find drugs that flush latent HIV out of its hiding places in the body, so all the virus can be eliminated, effectively curing the patient so they don’t have to take more antiviral drugs.

This isn’t much of a surprise. Unlike the examples of disease being fully cured as in the scenarios listed above, other diseases simply go dormant inside the body. The classic example of this is the family of herpes viruses. Many of you are aware that a herpes simplex virus can reappear after decades of being absent. Similarly, chicken pox and shingles – diseases caused by the herpes zoster virus – can reappear after having run their course during the initial infection. At this point it appears that HIV appears to be more like the herpes viruses in this regard than examples of other infections and disease that can be completely eradicated.

Despite theoretically reasonable possibilities about the prospect of receiving blood from someone who had been HIV-positive, it is currently not prudent to do so, even as we know HIV loads can be completely eliminated from the blood of patients. That is not the same as eliminating HIV from the body. Thus, the American Red Cross and other blood donations involved in blood transfusions will not accept donations from anyone ever having been HIV(+).

For those in need of a life-saving blood transfusion, having individuals step up to donate is vitally important. Please consider doing so.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!